Principles Of Intervention Flashcards
an ambition you want to achieve, based on the assessment results, current EBP, and family preferences
Goal
Example of goals (mcleod)
- improving the child’s speech intelligibility
- surgical repair of a cleft of the soft palate
- developing the child’s emergent literacy skills to ameliorate future risk of literacy difficulties
- developing a child and communication partner’s competence to use an AAC
- increasing the child’s verbal interaction with peers at preschool or school
- reducing immediate consequences of SSD
- equipping families with strategies for revolving communication breakdown
- increasing family members’ and relevant professionals’ \ knowledge about SSD to dispel false beliefs and myths, and
- improving communication partners’ abilities to listen to a child with SSD so that the child’s messages are understood
What are the 3 perspectives on how to manage SSD in children
● Impairment-based
● Social-based
● Biopsychosocial perspective using ICF
consistent with the medical model
Impairment based
Communication difficulty is in the child and that the difficulty can be treated by giving the child missing processing skills or knowledge
Imapirment-based perspective
goal of impairment-based perspective
Help the child learn the missing processing skills or knowledge
considers the impact of a child’s communication differences within society
Social-based perspective
Goal of social-based perspective
Socialization skills
integrates both the impairment and social perspectives
Biopsychosocial perspective using ICF
Operationally defined goals proponents
Hedge, Klein, and Moses
The 6 operationally defined goals are
- Behavior or attitude to be learned
- Tasks that will be used to measure
- Who will measure
- Setting where measurement will take place
- Criterion
- Total expected duration of intervention
a hierarchically organized network of goals designed to achieve a basic or long-term goal
Goal Framework
T or F number of goals within a hierarchy reflects both the nature of the problem and the impact of the problem
True
Summarizes what needs to be achieved before a child and his or her family can be dismissed from intervention services
Long-term goals
Describes the specific behavior or skill being targeted to achieve the LTG
Short-term goals
type of data collected over the course of intervention, to evaluate intervention efficacy
Generalization probes
Based on STGs.
Session goals
for any child with an SSD, who has a reactive temperament, and fear of failure.
Traditional approach
What do we do traditional approach?
Select an early, developing, stimulable speech sound from the list based on the analysis and work through that list developmentally and sound by sound
What are the traditional developmental intervention targets?
1.Processes that occur frequently but are optional.
2. Processes that affect sounds that are stimulable or sounds that are within a child’s phonetic inventory.
3. Processes that affect intelligibility
4. Processes that affect early developing sounds.
This is for any child with SSD, who has no confounding difficulties and is a confident risk-taker
Complexity Approach
What do we do in the complexity approach
One or two complex phonological targets are worked on to induce a widespread change in a child’s phonological system
the constituents or parts of systems, and how they interrelate with one another in organized hierarchies(
Complexity
process by which children’s phonological systems change is guided by
Learnability
Geirut (2001) proposed 4 categories for describing complexity targets:
○ complex articulatory phonetic factors
○ complex linguistic structures
○ complex clinical factors
○ complex psycholinguistic structure
Complex intervention targets
Non-stimulable, phonetically more complex segments or true consonant clusters that are associated with the least productive knowledge for an individual child.
for children with severe to profound phonological impairment.
Cycles Approach
Targets of cycle approach
processes or patterns in the child’s speech in a predetermined order.
CYCLES APPROACH is suited for children who have SSD characterized by:
○ primary target patterns
○ secondary target patterns
○ advanced target patterns
developed by Willams (2003) following the development of Systemic Phonological Analysis of Child’s Speech (SPACS)
Systemic (Functional) Approach
Systemic (functional) Approach considers
considers the functions of words within the child’s phonological system.
Systemic approach target selction
The selection of targets is based on the phoneme collapses.
recommended for children with large collapses of contrast in their phonological system.
Systemic approach
developed by Bernhardt & Stemberger in 2000. They used nonlinear phonological theories to guide the analysis of a child’s speech
Constraint-based nonlinear approach
We use nonlinear phonological theories to guide the analysis of a child’s speech to identify:
A. What a child knows about the phonological system:
i. segmental tier (i.e., sound segments and features)
ii. prosodic tier (i.e., phrase stress and
intonation, word length, word stress, word shape/sequences)
b. how a child’s knowledge of each tier interacts between tiers
c. what phonological knowledge is
missing that a child still needs
to learn.
Bernhardt & Stemberger (2000) suggest that you organize the results of your analysis into a framework of goal types
New words and phrase structures
○ New segments involving new feautures
○ New combinations of existing features
○ New sequences of structures and segments
GUIDING PRINCIPLES in CONSTRAINT-BASED NONLINEAR Target Selection
○ New features or segments should be targeted using established word structures, and new word structures should be targeted using established segments.
○ Selection of a goal or target from each of the four categories is recommended within intervention blocks that use a cyclical-goal attack strategy.
○ Cognitive-linguistic, personal-social, perceptual, and articulatory abilities should be considered even though non-default marked goals are preferred.
Consider selecting targets that would improve the intelligibility. Consider selecting more than one exemplar for each goal type.
recommended for any children who have SSD, who have e segmental or prosodic difficulties.
Constraint-Based Nonlinear Approach
based on Norris and Hoffman’s (2005) constellation model of language processing.
Neuro-Network Approach
General goals are identified in
Neuro-network approach
recommended for children with concomitant speech and language difficulties.
Neuronetwork Approach
Goals identified for children with articulation impairment typically involve:
target sounds
activities and participation
Gordon-Brannand & Weiss (2007) suggested that the selected sounds should be:
● correctly produced in one or more phonetic contexts
● most stimulable
● developed early
Goal Attack Strategies for articulation impairment
● Vertical Structure
● Horizontal Structure
● Cyclical Structure
Therapy Framework
● Antecedent
● Response
● Consequence Events
What does the Vertical Structure target
1 or 2 speech target (phoneme, PP, word structure, etc.)
Tasked is worked on until a predetermined criteria is met
Vertical structure
Suitable for articulation impairment and phonological impairment
Vertical structure
We provide multiple strategies for the child to learn 1 or 2 targets over a period of time
Vertical Structuring
Considered by Elbert and Geirut as training deep
Vertical structure
Considered as training wide by elbert and geirut
Horizontal structure
What does the horizontal structure target?
3 or more targets that help with phonological impairment
Enhances motor learning for MSD
Horizontal structure
Speech production target over a specified time independent of accuracy
Cyclical Structure
Similarities of CS to VS and HS
Like vs because 1 speech target pattern is targeted per session
Like hs because targets are worked on for a period of time
delineation of stimulus events designed to elicit a response
Antecedent
An antecedent could be
a verbal model, picture, printed material, or verbal instruction
behavior targeted by the clinician
Response
Response ranges from
It ranges from approximation of the desired behavior to production of the behavior in connected speech
stabilized at one level of complexity before proceeding to the next level
Response
Can be a reinforcement/punishment or feedback that follows the response
Consequence Events
Tokens, points, chips
Tangible consequents
smile or verbal
feedback
Informal reinforcers
Treatment schedule is determined by the following:
○ client’s age
○ attention span
○ severity of the disorder
○ financial resources
availability of instructional services
size of the clinician’s caseload treatment models (pull out vs classroom-based instruction)
refers to two or three sessions
each week over an extended period of time
Intermittent scheduling
refers to daily sessions for a shorter temporal span (such as an eight-week block)
Block scheduling
T or F Block scheduling was more efficient in achieving articulatory/phonological progress than was intermittent scheduling
TRUE
the client is instructed in a treatment room
Pull out model
the client is instructed in a classroom setting
Inclusion Model
a. The clinician presents antecedent instructional events followed by client responses.
b. The client has little control over the rate and presentation of training stimuli.
Drill
This differs from drill by
including an antecedent
motivational event
DRILL PLAY
similar to drill play, but training stimuli are presented as activities
Structured Play
Clinician arranges activities so that the target responses occur as a natural component of the activity and they may also use modeling self-talk and other techniques to elicit responses from the child,
Play
process by which desired change in behavior in an intervention context facilitates change in the same behavior and/or different but related behaviors in non-intervention contexts.
Generalization
This is the most important outcome of intervention.
Generalization
2 types of generalization:
- Stimulus generalization
- Response generalization
It occurs when a trained behavior is evoked with different stimuli
Stimulus generalization
process in which responses that have been taught carry over to other behaviors that are not taugh
Response generalization
various types of generalization that are expected in the articulation process:
across word position/context generalization
across linguistic unit generalization
across sound and across features generalization
across situations generalization
■ generalization from a word position that is not taught
■ contextual generalization (also called phonetic context transfer)
across word position/context generalization
shifting correct sound productions from one level of linguistic complexity to another (e.g., from syllables to words)
Across linguistic unit generalization
■ the correct production of the target sound generalizes from one sound to another
■ It occurs most often with sound classes and/or between phonetically similar sounds
across sound and across features generalization
also known as situational generalization
transfer of behaviors taught in the clinical setting to other situations and locations, such as school, work, or home.
across situations generalization
STEPS in FACILITATING SELF-MONITORING
- The clinician monitors and provides verbal feedback
- The clinician monitors and provides nonverbal cueing (raises finder, head nod)
- The client “corrects“ themselves when they hear errors
- The client anticipates the errors and self-corrects.
- The correct productions are automatic.
Important concepts in discharge
● maintenance phase
● automatization
● retention
● intersession retention
● habitual retention
Elbert (1967) suggested dismissal might be based on 2 questions:
○ Has the maximum change in this individual’s speech behavior been attained?
○ Can this individual maintain this level of speech behavior and continue to improve with additional speech instruction?
